Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow‐up through 2016

Abstract

Background To determine if construction and trades workers employed at U.S. Department of Energy (DOE) nuclear sites facilities are at significant risk for diseases associated with occupational exposures, we compared the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed) to that of the US population. Methods The cohort includes 24,086 BTMed participants enrolled between 1998 and 2016 and 5203 deaths. Cause‐specific standardized mortality ratios were calculated based on US death rates. Results Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease, asbestosis, transportation injuries, and other injuries, particularly those caused by accidental poisoning, suggesting a possible effect of the opioid epidemic. Conclusions Apart from other injuries, mortality patterns were very similar to those reported in the past in this population. Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Risks are associated with employment during all time periods covered including possibly after 1990. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. The high risk of lung cancer supports the value of early lung cancer detection. Continued medical surveillance is important.

Lung cancer mortality among construction workers: implications for early detection

“…The BTMed medical protocol has been described in prior publications3–5 9–15 and includes: a work history interview; a medical history and symptom questionnaire; a comprehensive physical examination; a posterior-anterior chest radiograph classified by a B-reader according to International Labour Office (ILO) Classification of Radiographs of Pneumoconiosis16 17; audiometry; a panel of blood tests chosen to assess organ damage from identified toxins; beryllium lymphocyte proliferation test (BeLPT; a blood test for beryllium sensitisation); stool faecal immunochemical testing; and spirometry meeting American Thoracic Society (ATS) standards 18 19. In 2011, BTMed began offering LDCT screening for workers meeting eligibility requirements 15…”

“…The most recent overall mortality cohort included 24 096 workers participating in BTMed between 1 January 1998 and 31 December 2016 4. The current study was restricted to 352 lung cancer deaths among 17 069 workers who completed initial medical examinations with chest radiographs and spirometry and had data on other covariates considered in the statistical models.…”

“…Construction workers are occupationally exposed to a number of respiratory carcinogens including asbestos, silica, beryllium and welding fumes. Prior studies have demonstrated elevated risk of lung cancer among these workers 1–5…”

“…The Building Trades National Medical Screening Program (BTMed) is an occupational medical screening programme for construction trades workers previously employed in USA nuclear weapons facilities. BTMed participants are at significantly increased risk of lung cancer 3–5. The current study investigated lung cancer mortality risk factors among BTMed participants included in a recent mortality update of this cohort 4.…”

“…BTMed participants are at significantly increased risk of lung cancer 3–5. The current study investigated lung cancer mortality risk factors among BTMed participants included in a recent mortality update of this cohort 4. Study objectives were to develop a predictive model for lung cancer mortality incorporating occupational and non-occupational risk factors and to evaluate potential use of the model for targeting high-risk individuals for lung cancer screening.…”